孕产妇死亡影响因素分析

目的分析孕产妇死亡原因,总结孕产妇死亡救治中存在的问题。方法回顾性分析成都市2007~2012年115例孕产妇死亡原因及评审情况。结果 2007~2012年孕产妇死亡率大致呈逐年下降趋势,2012年孕产妇死亡率明显低于2007年,差异有统计学意义(P0.05)。115例死亡孕产妇中直接产科原因死亡60例(52.17%);间接产科原因死亡55例(47.83%);产科出血(41例)仍居首位,占直接产科原因的68.33%。直接产科原因中产前检查次数5次(含0次)的死亡孕产妇占61.67%,明显高于产前检查5次以上的孕产妇死亡数;而间接产科原因中产前检查次数5次(含0次)的死亡孕产妇占60.00%,也明显高于产前检查5次以上的孕产妇死亡数,两者比较差异均有统计学意义(P0.05)。在省市级医院死亡的孕产妇数量明显多于县级医院、乡镇卫生院及其他(P0.05)。可避免死亡占63.48%,不可避免死亡占36.52%,其中各级医务人员的知识技能问题在可避免死亡孕产妇(73例)的首要影响因素中占首位,为93.15%(68/73),个人及家庭知识技能问题占6.85%,差异有统计学意义(P0.05)。结论影响孕产妇可避免死亡的首要原因是各级医务人员知识技能欠缺,责任心不强。切实加强医疗助产机构的业务培训及监管,是降低孕产妇死亡的重要措施。

Analysis on influence factors of maternal death

Objective To analyze the influence factors of maternal death and summarize the problems existing in treatment process of maternal death .Methods The data about causes of death and monitoring records in 115 pregnant women of Chengdu city were retrospectively analyzed .Results Maternal mortality rate showed downward trend year by year from 2007 to 2012.Maternal mortality rate of 2012 was much lower than that of 2007 and the difference was significant (P<0.05).Among 115 cases, the number of direct obstetric causes of death were 60 cases, accounting for 52.17 % and indirect obstetric causes of death were 55 cases, accounting for 47.83 %.Obstetric hemorrhage was the first cause (68.33 %) among direct obstetric causes of maternal death .The amount of dead parturient women with less than 5 times of antenatal examination was much higher than which with over 5 times of antenatal examination ( P<0.05) .The amount of dead parturient women in the provincial and municipal hospitals were more than that in the county and township hospitals ( P<0.05) .Among all 115 dead parturient women , 73 cases were avoidable deaths , accounting for 63.48 %and the other 42 cases were unavoidable deaths , accounting for 36.52 %.The most influence factor of avoidable deaths was the knowledge and skills of medical staff , accounting for 93.15%, which was higher than other factors as the knowledge and skills of persons and families(P<0.05).Conclusion Less knowledge, skills and responsibility are the most influence factors of avoidable maternal death causes .The important measures for reducing maternal mortality rate is to strength the training and the supervision of medical and midwifery institutions .